Hari Krishan AGGARWAL, Deepak JAIN, Sonia SINDHU, Raj YADAV

Evaluation of role of low molecular weight heparin and vitamin e on renal functions in patients with diabetic nephropathy

Amaç: Diyabetin son dönem böbrek yetmezliği riskini artırdığı bildirilmiştir. Diyabetik nefropatinin ilerlemesini önlemede yeni yaklaşımlar gereklidir, çünkü iyi metabolik kontrole rağmen diyabetik hastalar ilerleyici böbrek hasarı gösterir. Bu çalışmanın amacı düşük molekül ağırlıklı heparin ve vitamin E’nin diyabetik nefropatili hastalardaki rolünü araştırmaktır. Gereç ve yöntem: Klinik olarak kanıtlanmış, yeterli glisemik kontolu ve kan basıncı kontrolu insulin, oral hipoglisemikler ve kan basıncı düşürücüler (ACE inhibitörü ve ARB’ler hariç) ile sağlanmış, diyabetik nefropatisi olan 25 erişkin hasta çalışmaya dahil edildi. Çalışmanın başlangıcında hastalara DMAH (3200 Ünite, subkutan günde bir kez) bir ay verildi ve takiben bir ay beklenip daha sonra üç ay süreyle E vitamini (Günde bir kez 200 mg) verildi. Bulgular: Hastaların bazal mikroalbuminüri değerleri, 41.0 ile 290.0 mg/24 st arasında değişiyordu. Bir aylık DMAH bu değeri 133.0 ± 74.4 mg/24 st’den 93.3 ± 62.1 mg/24 st’e düşürdü (p 0.05). Mikroalbuminüri değerleri çalışma süresi olan 5 ayın sonunda başlangıçtaki bazal değerlere dönmemiş olduğu görüldü. Sonuç: Çalışmamızın sonuçlarına göre, standart tedavi rejiminin bir parçası olmasa bile, DMAH ve takiben vitamin E tedavisinin diabetik nefropati beklenen dönemde dikkate alınması gerekir.

Diyabetik nefropatili hastalarda düşük molekül ağırlıklı heparin ile vitamin E’nin böbrek fonksiyonları üzerine etkisi

Objectives: Diabetes has been reported to increase the risk of end stage renal disease. To prevent the progression of diabetic nephropathy (DN) search for newer approaches is warranted as diabetic patients despite good metabolic control show progressive renal damage. The aim of this study was to investigate the role of low molecular heparin (LWMH) and vitamin E in patients with diabetic nephropathy. Materials and methods: Twenty five clinically proved adult cases of DN with adequate glycemic and blood pressure control achieved with insulin or oral hypoglycemics and anti hypertensive agents (excluding ACE inhibitors and ARBs) were included. At the start of the study, patients were put on LWMH (3200 IU S/C once daily) for one month and thereafter a washout period of one month was given, following which patients received anti-oxidant vitamin-E (200mg, once daily) for three months. Results: Patients at the baseline have microalbuminuria levels ranging for 41.0 to 290.0 mg/ 24hr. One month of LMWH reduced it from 133.0±74.4 to 93.3±62.1 mg/24hr (p<0.001). Vitamin E supplementation for 3 months did not bring any statistically significant change in the values of microalbuminuria which varied from 95.2±13.0 to 94.2±12.9 mg/24hr (p>0.05). The microalbuminuria levels did not revert back to the baseline till the end of the study (5 months). Conclusion: Our results indicated that, though not a part of standard regime, LMWH treatment followed by vitamin E supplementation needs to be considered in the incipient stage of DN.

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